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How Does Medicare For All Work

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How Would Medicare For All Change That

How Medicare-For-All Works In Australia

Medicare for All would switch the system from multi-payer to single-payer. In the plans proposed by several prominent Democrats, this means that only one entity would be responsible for distributing health care and paying for it. Private insurance would not be involved, and the federal government would undertake the responsibility of overseeing health coverage and payments. The proposed Medicare for All plans are mainly taxpayer-funded, and their stated goal is to bring the uninsured rate down to 0%.

These plans also aim to reduce or eliminate “out-of-pocket costs,” fees related to health care services that patients must pay for themselves. This includes co-pays and deductibles for those with insurance, and may include the full cost of services for those without.

Medicare For Alls Jobs Problem

The big Democratic talking point has a big political weakness: It could wipe out thousands of jobs in places like Pittsburgh that have built their new economies on health care.

Scott Goldsmith for Politico Magazine

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Rachana Pradhan is a health care reporter for POLITICO Pro.

PITTSBURGH, Pa. Deanna Mazur, the daughter of a retired steel mill worker who works as a medical billing manager, finds some things to like about the Medicare for All policy that shes been hearing politicians talk about. She likes the notion that all Americans would have health insurance. And it would simplify her own job quite a bit if there were only one place to send medical bills, instead of the web of private companies and government programs that she deals with now. It would definitely be easier, Mazur says.

Then again, if it were that easy, her job might not exist at all.

Mazurs job and those of millions of others have helped turn health care into the largest sector of the nations economy, a multitrillion-dollar industry consisting in part of a huge network of payers, processers, and specialists in the complex world of making sure everything in the system gets paid for. If the health care system were actually restructured to eliminate private insurance, the way Medicare for Alls advocates ultimately envision it, a lot of people with steady, good-paying jobs right now might find themselves out of work.

What if my job doesnt exist anymore? she asked in a recent interview.

Would Consumers Be Able To Keep The Coverage They Have Now

Under many of the proposed plans, consumers could keep their coverage. The Public Option plan, for example, would add a new coverage option, as would a Medicare Buy-In. However, under Medicare for All, every US citizen would move to the new plan coverage through other programs such as employer-based coverage and Medicaid would end.

Also Check: What Is The Average Medicare Supplement Premium

How Does It Work And What Does It Cover

The first thing that happens under Medicare For All is that Medicare, as it exists presently, is expanded. If you’ve ever looked at the giant catalog that the government sends out now to people when they become eligible for Medicare, you know what a confusing and inefficient thing it is. New Medicare For All gets expanded. What does that mean? That means there are no more co-pays, no more deductibles, no more “Part A, Part B, Part D”, and no more having to choose supplementary coverage from your state’s offering. Dental, hearing, and vison are covered under Medicare For All.

In the first year people are eligible beginning from age 55, instead of 65. People from birth to their 19th birthday are also automatically covered.

Will Preexisting Conditions Be Covered

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Yes. Under the Affordable Care Act, a health insurer cant refuse to give you coverage because of a health issue you already have. That includes cancer, diabetes, asthma, and even high blood pressure.

Before the ACA, private insurers were allowed to turn down prospective members, charge higher premiums, or limit benefits based on your health history.

Medicare for All plans will operate in the same way as the ACA.

Recommended Reading: Where Can I Get Medicare Information

Wont Our Aging Population Bankrupt The System

The experience of other nations show this fear is unfounded.

Studies show that the aging of the population is responsible for only a small fraction of our rising health care costs. Moreover, European nations and Japan have much higher percentages of elderly citizens than the U.S. does, yet their health systems remain stable with much lower health spending. The lesson is that national health insurance is a critical component of long-term cost control. In addition to freeing up resources by eliminating private insurance waste, single payer encourages prevention through universal access and supporting less costly home-based long-term care rather than institutionalization.

Wont Single Payer Result In Rationing And Long Waiting Lines

Not with good management and our nations abundant medical resources.

No. It will eliminate the rationing going on today. The U.S. already rations care based on ability to pay: if you can afford care, you get it if you cant, you dont.

In 2017, an estimated 30,000 unnecessary, preventable deaths were linked to lack of health insurance. Many more people skipped treatments that their insurance company refused to cover. Those are forms of rationing.

A single-payer system will ensure that everyone has access to a single tier of high-quality care, based on medical need, not ability to pay.

Long wait times for non-urgent procedures in some countries, e.g. hip replacements in Canada, are often cited by opponents of single-payer reform as an inevitable consequence of universal, publicly financed health systems. They are not. Wait times are a function of a health systems capacity and its ability to monitor and manage patient flow. In recent years Canada has shortened wait times for non-urgent procedures by using better queuing techniques. In the case of urgent care, wait times have never been an issue. Moreover, we spend twice as much per person as Canada does, enough to assure that we wouldnt have waits in our single payer system.

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How Will Single Payer Impact The Business Community

Single payer will eliminate the costly distraction of administering health benefits.

The ability of U.S. businesses to accurately budget for their employees health care expenses is critical, but nearly impossible in todays environment. Costs are subject to steep, unpredictable increases, and are unevenly and unfairly distributed. Companies that provide generous benefits, and those with older or sicker workers face crippling costs, while others evade their responsibility to chip in, leaving their employees with no or inadequate coverage.

In contrast, nations that manage health care expenses in a single risk pool provide their businesses with much greater financial predictability, and costs are distributed more fairly. Thanks to a single-payer systems ability to reduce needless uncertainty and variation in one part of the budget, a company will be able to allocate more resources toward activities that directly enhance its central business mission and its ability to compete in the global marketplace.

What Is The Proposed Financing Mechanism

How Would âMedicare-For-Allâ Work? | Velshi & Ruhle | MSNBC
  • Medicare for All: One proposal would aim to fund the program entirely through taxes. Options include higher employer payroll taxes and increased taxes on corporations and high-income households.15
  • Medicare for all who want it: Premiums paid by enrollees and a payroll tax on employers that do not provide qualifying coverage. Increases taxes on high-income households and raises the Medicare payroll tax.16
  • Medicare for more: Establishes a new Medicare Buy-In Trust Fund that would be funded by premiums paid by eligible individuals.17
  • Public option: Premiums that enrollees pay into the program.18

Also Check: What Is The Deadline For Changing Medicare Plans

The Basics Of Medicare For All

What to know about Bernie Sanderss health care plan.

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Its possible youve tuned out when the Democrats running for president have tussled over Medicare for all. But now that Bernie Sanders, who introduced the Medicare for All Act in the Senate, is ascending in the nominating contest, its a good time to take a closer look at what it would mean for the health system, your health insurance and finances, and the federal budget.

Heres our quick primer, with some suggestions for further reading.

How Medicare For All Might Work

A Congressional Budget Office analysis in 2020 found that Medicare for All would dramatically increase federal government spendingbut health care providers and patients would pay less, and it would make health care coverage nearly universal. The government would likely have to raise taxes in order to pay for a Medicare for All-type program.

For-profit health care providers, like your dentist or primary care physician, would likely take a substantial financial hit if all medical services in the U.S. were run by the government. This is one of the reasons the American Medical Association, many of whose constituents may stand to lose some profits under a non-privatized system, has a long history of lobbying against a federally subsidized health care system.

However, Medicare for All is only one of the options being considered for health care coverage expansion the public option is the other, and this appears to be the path Biden favors.

In late 2020, Biden proposed his own version of health care reform, called Bidencare, which aims to improve on the Affordable Care Act. Unlike Medicare for All, Bidencare aims to provide universal health care through a mix of public and private options rather than one centralized government entity.

Also Check: How Much Does Medicare Cover For Hip Replacement

How Does Medicare Advantage Work

Medicare Advantage bundles your Part A, Part B, and usually Part D coverage into one plan. Plans may offer some extra benefits that Original Medicare doesnt cover like vision, hearing, and dental services.

You join a plan offered by Medicare-approved private companies that follow rules set by Medicare. Each plan can have different rules for how you get services, like needing referrals to see a specialist. Costs for monthly premiums and services you get vary depending on which plan you join.

Plans must cover all emergency and urgent care, and almost all medically necessary services Original Medicare covers. Some plans tailor their benefit packages to offer additional benefits to treat specific conditions.

With Medicare Advantage, you:

  • Need to use doctors who are in the plans network .
  • May pay a premium for the plan in addition to the monthly Part B premium. Plans may have a $0 premium or may help pay all or part of your Part B premiums.
  • Cant buy or use separate supplemental coverage .

You must have both Part A and Part B to join a Medicare Advantage Plan.

How does Medicare work with my other insurance?

When you have Medicare and other health insurance , one will pay first and the other second .

If you have other insurance, who pays first depends on a number of items, like if youre still working, the type of insurance you have, and if you have a special situation, like End-Stage Renal Disease .

What Wouldnt The Program Cover

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Under the comprehensive Sanders program, the only things you would probably have to pay for would be certain elective and cosmetic procedures. It could eliminate much of the private insurance system as we know it. Private plans could exist to cover the few procedures not included in the plan.

Other proposals aim to keep the private insurance system and add an expanded Medicare or public option.

Also, keep in mind that Medicare pays doctors and hospitals less than private insurers for services, and not all hospital systems or doctors accept Medicare. The American Hospital Association found that private health plans pay hospitals about 45% more than treatment costs, while Medicare and Medicaid pay about 12% less than costs, a difference of 57 percentage points If we moved to a Medicare for All system, would all hospitals and doctors agree to this pay cut? Would they organize to demand more? These are the kind of questions that architects of an expanded system have to wrestle with.

If Sanders Medicare for All were to become law, it wouldnt happen overnight. It would roll out over four years.

In the first year, Medicare would grow, with the eligibility age dropping to 55 and with all children 18 and younger added to the rolls. Over the next two years, the age would drop to 45 and then 35. By the fourth year, it would truly become Medicare for all.

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Can Medicare For All Really Work

While the idea of a single-payer health care systemso-called Medicare for allis gaining popularity among Democrats, some experts say that implementing such a system presents major challenges.

In an October 26, 2018 article in the MetroWest Daily News, John McDonough, professor of the practice of public health at Harvard T.H. Chan School of Public Health, said, If I ruled the world, the first thing I would do is implement single-payer. At the same time, I feel like getting from here to there is not possible.

McDonough, who helped write the Affordable Care Act, said it would be extremely difficult to replace the current entrenched health care system, with cost being the biggest roadblock.

How are you going to pay for it? he asked. The level of taxation that would be required to replace private premiums would be seen as off the wall by most people.

How Does Medicare Work

Generally, you only need to sign up for Part A and Part B once. Each year, you can choose which way you get your health coverage .

Medicare is different from private insurance it doesnt offer plans for couples or families. You dont have to make the same choice as your spouse.

2 steps to set up your Medicare coverage:

  • You can sign up at certain times. Check when and how to sign up.
  • Choose which way you want to get your Medicare health coverage You can choose either Original Medicare or Medicare Advantage for your health coverage. If you choose Original Medicare, youll also decide if you want drug coverage and supplemental coverage, like Medigap.
  • Youll have Original Medicare unless you join a Medicare Advantage Plan.

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    What Benefits Get Covered

    Bottom line: Democrats generally agree that health insurance should cover a wide array of benefits, although there is some variation around how different plans cover long-term care, dental, vision, and abortion.

    Every country with a national health care system has to decide what type of medical services it will pay for. Hospital trips and doctor visits are almost certainly included. But there is wide variation on how health care systems cover things like vision, dental, and mental health.

    Covering more services mean citizens have more robust access to health care. But that also costs money and a more generous health care plan is going to require more tax revenue to pay for all that health care.

    Even Medicare, as it currently stands, has a relatively limited benefit package. It does not cover prescription drugs, for example, nor does it pay for eyeglasses or long-term care.

    Instead, many seniors often take out supplemental policies to pay for those services or end up selling off their assets to pay for care in a nursing home.

    Tips For Keeping Your Finances Healthy

    What Does “Medicare for All” Really Mean?
    • A health savings account may be a good option for younger people who are worried about potential healthcare costs. HSAs can greatly reduce monthly premiums.
    • Whatever the outcome on Medicare for All, it is important to keep yourself physically and financially healthy. If you are concerned about budgeting with health care costs, you may want to look into a financial advisor. SmartAsset can help you find your financial advisor match here.

    Also Check: What Is The Medicare G Plan

    How Medicare For All Could Affect The Health Care System

    Medicare for All would shake up pretty much every part of our nations health care system, from the doctors who provide care to the insurers who pay for it. Heres how the plan could affect different types of providers:

    • Doctors and Hospitals. They would most likely receive less pay under the new system because Medicare pays lower rates for all forms of care than private insurers do. On the plus side, they would no longer have to worry about unpaid bills from patients who dont have insurance or insurers who refuse claims. They would also have to spend less time on paperwork, which would keep their administrative costs down. Still, the lower payment rates could force some hospitals to close if they can no longer meet their expenses.
    • Drug Companies. Once the government takes over the health insurance system, it would be able to negotiate for lower prices on drugs across the board. As a result, the companies that make these drugs would most likely see their profits drop. In the long run, that could discourage them from spending money to develop new medicines.
    • Health Insurers. Private health insurers would most likely go out of business as the new program takes over. As a result, people who work for these companies would lose their jobs if the program goes into effect. Sanderss plan sets aside up to 1% of the governments total health spending budget for the first five years of the program to help displaced workers find new jobs.

    Is There Support For This Approach In Congress

    Support in the House and Senate is at an all-time high.

    The Medicare for All Act of 2019, H.R. 1384, is currently in Congress. The bill would establish an American single-payer health insurance system, publicly financed and privately delivered, that builds on the existing Medicare program. H.R. 1384 was introduced by Rep. Pramila Jayapal and more than 100 co-sponsors in February of 2019. Its predecessor, H.R. 676, was co-sponsored by a majority of the House Democratic caucus in the previous Congress.

    Polls over the past two decades show that about two-thirds of the U.S. population supports this approach.

    On the Senate side, Sen. Bernie Sanders has introduced the Medicare for All Act of 2019, S. 1129, which had 14 original co-sponsors. PNHP has welcomed Sanders bill, but notes it could be strengthened in several important ways.

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